Most TFL-Eligible Vets Won’t See Higher VA Costs

In your recent column explaining how some retirees who are eligible for TRICARE for Life (TFL) will face higher outpatient costs at VA hospitals and clinics Oct. 1, you don't explain this:

Will a retired military person with a 10 percent VA disability rating have to pay VA for health services provided for conditions unrelated to the rated disability?

I have a 1993 letter saying I will be treated at the VA for conditions other than that for which the VA issued my 10 percent. I read into your article that if a person has a service-connected disability award at all, that person will be treated without cost at a VA facility.

My priority category at VA is three.

Please tell me if I'll be charged for services at the VA hospital for other than the condition that brought me my 10 percent disability award.

I read your articles with great interest and will continue to do so. Thank you for the great services you provide to veterans.

DAVID OSTROM
USA-Ret.

Higher priority veterans won't be impacted. For example, Priority 3 veterans like you – those with VA disability ratings of 10 to 40 percent – will continue to receive cost-free VA care for any condition. The only VA costs Priority 3 users face is a co-payment of $8 on outpatient medications for non-service-connected conditions.

Veterans eligible for TRICARE have an option when they enter a VA health facility, to elect to be seen as a veteran or as a TRICARE patient, says Daryl Claggett, the Veteran Health Administration's deputy director of e-business solutions. It's a safe bet that fewer elderly military retirees will want to use TRICARE at VA facilities after Oct. 1.

If a patient with a service-connected disability rated 10 percent to 40 percent elects to be seen as a veteran, all costs will be covered except co-pays for outpatient medications as described above. If they enter as a TRICARE for Life patient, they would be seen only if TRICARE spaces are available and they would pay the higher outpatient costs planned for TFL users at VA facilities starting Oct. 1.

Veterans rated 50 percent or higher have no costs whatsoever at VA facilities so there would be no reason for them to elect to receive VA care as a TRICARE patient.

Older military retirees using the VA medical system who have no service-connected conditions or zero-rated disabilities have found it cheaper in the past to use TRICARE-for-Life benefits at VA. As my column on this issue explained, that will become a far less attractive option starting Oct. 1. – Tom Philpott

MADE MEDICARE PAY

If VA hospitals and clinics can accept TRICARE for Life, then why can't they take Medicare? If the VA is a federal program and Medicare is a federal program, then why is the VA not Medicare certified?

The VA should be able to go after Medicare to pay its fair share.

EDWARD J. TESSIER
Via email

VA should get their facilities Medicare-certified. It's that simple. Private vendors do it every day.

STANLEY BOYLE

Medical Service Corps, USAF
Via email

Congress doesn't allow VA facilities to be Medicare certified because that would be one more hole in the bucket of a Medicare trust fund, which is expected to run out of money by 2026. Congress believes VA healthcare dollars should be used to treat veterans.

Some veteran service organizations are good with that because they believe Congress would use any Medicare funding of VA health care as an excuse to cut VA appropriations rather than use those freed up VA dollars to expand VA services. – Tom Philpott

KEEP TRICARE PRIME REMOTE

Who made the decision to cut TRICARE Prime coverage for those outside of a 40-mile radius of military treatment facilities?

Having written my congressman, who is very opposed to this move, I would like to know the name of the person who came up with this so I could demand his immediate relief-for-cause.

This bureaucrat is incapable of making sound monetary decisions that affect others, and should be identified and investigated. Unfortunately, these decision makers are always hidden from public view. This needs to change. Could you name the person who actually decided to eliminate TRICARE Prime for more than hundred thousand retirees?

URIAH S.

There is no single official to blame or credit for this one.

The end of TRICARE Prime outside of 40-mile "catchment" areas of military treatment facilities has been expected since 2007, when Defense officials drafted the third generation of TRICARE support contracts. The intent is to return the managed care option to its original concept of being a backup network to military clinics and hospitals when they can't provide care to all beneficiaries living nearby, or in areas where bases have been closed and military health facilities shuttered.

Through the first two TRICARE contracts, based on an assumption that managed care saved money, contractors were offered incentives to establish networks beyond 40-mile catchment areas. In the South Region, the contractor offered Prime everywhere. But experience show that providing managed care far from bases only adds to military health care costs.

So the new generation of support contracts were written to constrict Prime service areas. Officials wanted this to occur across all regions simultaneously but contract protests prevented that until last year. Then the administration decided to delay restricting Prime areas until after last year's election cycle so it wouldn't be a campaign issue.

So who is to blame? You have a choice. The new support contracts were drafted during the Bush administration. They are being implemented under the Obama administration.

The House version of the 2014 defense authorization bill has language that would stop TRICARE from ending Prime coverage outside of 40 miles for current enrollees. But no new enrollees would be added. A House-Senate conference committee will have to decide whether to accept that language. Meanwhile, Defense officials continue to plan to shut down these Prime networks for 171,000 enrollees effective Oct. 1. – Tom P.